The relationship of depression to antiepileptic drug adherence and quality of life in epilepsy.

We sought to examine the impact of depression upon antiepileptic drug (AED) adherence in patients with epilepsy. We administered the Center for Epidemiologic Studies Depression Scale (CES-D), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Seizure Severity Questionnaire (SSQ), and Quality of Life in Epilepsy-10 (QOLIE-10) and measured AED adherence by utilizing the medication possession ratio (MPR) in adult patients with epilepsy identified through a pharmacy claims database. From a sampling frame of over 10,000 patients identified in claims, 2750 were randomly selected and contacted directly by mail to participate in the cross-sectional survey. A total of 465 eligible patients completed a survey. Survey data were combined with administrative claims data for analysis. We conducted a path analysis to assess the relationships between depression, adherence, seizure severity, and quality of life (QOL). Patients with depression scored significantly worse on measures of seizure severity (p=.003), QOL (p<.001), and adherence (p=.001). On path analysis, depression and QOL and seizure severity and QOL were related, but only the NDDI-E scores had a significant relationship with medication adherence (p=.001). Depression as measured by the NDDI-E was correlated with an increased risk of AED nonadherence. Depression or seizure severity adversely impacted QOL. These results demonstrate yet another important reason to screen for depression in epilepsy.

A comparison of physicians' attitudes and beliefs regarding driving for persons with epilepsy.

OBJECTIVE: The purpose of this survey was to compare attitudes and opinions regarding driving restrictions for persons with epilepsy (PWE) between internal medicine and general practice physicians and neurologists. METHOD: A questionnaire aimed at eliciting physicians' perspectives related to driving with epilepsy was developed that focused on physicians' experiences and opinions with respect to driving issues for PWE. Three groups of physician subspecialties were targeted based on the likelihood of persons with epilepsy in their practice: neurologists, family practice physicians, and internal medicine practitioners. Questions asked about driving with controlled and uncontrolled seizures, predictable auras, nocturnal seizures, seizures without loss of consciousness, patient reporting, seizure-related accidents, and patient justifications for driving. RESULTS: Error rates were high with respect to knowledge of state reporting practices, especially among family practitioners and internal medicine physicians. Family practitioners and internists were less likely than neurologists to support driving for people with uncontrolled seizures under specific conditions and more likely to support a minimum seizure-free period before issuing a driver's license and mandatory reporting of seizure information. Physicians who thought they were from states with mandatory reporting were more supportive of mandatory reporting of seizure information and setting a minimum seizure-free period before a driver's license is issued. Physicians having fewer patients with epilepsy were more likely to oppose driving in persons with intractable seizures. CONCLUSION: Nonneurologists have more restrictive beliefs regarding driving for PWE, who are in fact allowed to drive in many states. Nonneurologists, in particular, demonstrated poor knowledge of state reporting requirements for PWE. The data from this study support a significant effort to promote education of all physicians regarding state regulations and aspects of epilepsy related to driving.